| NPI | 1700335247 |
|---|---|
| Doing Business As | GLEN LAKE OPTICAL |
| Entity Type | Organization |
| Authorized Contact | JENNIE J SEALOCK Secr/Treas 763-551-0529 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2019-02-06 |